Arthroscopic treatment of bidirectional glenohumeral instability: two- to five-year follow-up.

Abstract

This investigation presents the results of arthroscopic repair of bidirectional (inferior with either an anterior or a posterior component) glenohumeral instability in 54 patients with 2-year minimum follow-up. The study group consisted of 43 males and 11 females. The average age at the time of operation was 32 years (range, 15-55 years); the average interval from operation to final evaluation was 34 months (range, 26-63 months). The American Shoulder and Elbow Surgeons' Shoulder Index and the Constant, Rowe, and University of California at Los Angeles scores were recorded preoperatively and at final evaluation. Preoperatively, no patients rated good to excellent overall (according to the Rowe Scale), whereas at final follow-up 91% (49 of 54 patients) rated good to excellent. The American Shoulder and Elbow Surgeons' Shoulder Index improved to 94 from 45.5 (P =.001). The absolute Constant score improved to 92 from 57 (P =.001). The Rowe score improved to 92 from 20.3 (P =.001). The University of California at Los Angeles total score improved to 32.7 from 18.6 (P =.001). Average passive external rotation at 90 degrees of abduction measured 89.5 degrees. Forty patients returned to sports, but 10 (25%) of these patients participated at a lower level. For each of 4 patients, the index operation was considered a failure because of persistent instability; 1 patient underwent a second operative procedure. Thermal capsulorraphy (with a Holmium laser) of the glenohumeral ligaments was used to supplement suture repair, but in no shoulder was thermal capsulorraphy used as the only treatment. The etiology of bidirectional glenohumeral instability is complex, and operative correction of multiple intraarticular lesions was necessary.